Psychopharmacology of multiple sclerosis

A variety of neuropsychiatric problems can occur in people with multiple sclerosis (MS) and these are often among the most important determinants of their quality of life. Taken together, a high prevalence of depression, anxiety, fatigue, and cognitive problems means that most people with MS end up struggling with one or more of these neuropsychiatric difficulties. Although these problems manifest across a broad range of severity, this is often a burdensome struggle. Pharmacologic treatments are an important domain of therapeutic intervention. Unfortunately, the use of these medications is supported by a very limited literature. Clinicians often must make clinical decisions about the use of psychopharmacologic treatments in the absence of guidance from high quality evidence. This requires synthesizing clinical information about MS with more general principles of psychiatric and psychopharmacologic care. This chapter provides such a synthesis of available evidence as it pertains to the most important neuropsychiatric syndromes in MS. The goal is to help facilitate effective psychopharmacologic treatment, which, in turn, can translate into better quality of life for people with MS.